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The Office of the Dead (illustrated by a funeral, burial, or a scene from the Book of Job)

Suffrages and additional prayers (optional prayers for particular saints or events, sometimes illustrated by portraits of the particular saints)

When faced with a Book of Hours, the first step is to identify the contents and determine if anything obvious is missing or is out of order. Then you can go through more carefully looking for clues.

While conducting my initial survey, I could see that something was wrong. There were only five miniatures in the Hours of the Virgin instead of the expected eight. A comparison of the text with the online Hypertext Book of Hours confirmed that several sections of the Hours of the Virgin were missing: the end of Terce, the beginning and end of Sext, all of None, and most of Vespers. In addition, the Office of the Dead was interrupted twice, by the Hours of the Cross and by the Hours of the Holy Spirit. Sometimes the Hours of the Cross and the Hours of the Holy Spirit are inserted into the middle of the Hours of the Virgin (the term is “intercalated”), but never into the Office of the Dead. Clearly something was out of sequence here as well.

I set the codicological issues aside and began working on identifying the liturgical use of the manuscript, that is, identifying the place for which it was made. This is often different than the place in which it was made.

Stylistically, the manuscript can be localized to northern France, possibly Rouen, and dates to around 1460-70. In private correspondence, art historian James Marrow observed that the illumination style is similar to the workshop of the Masters of the Échevinage de Rouen, a workshop active in Rouen and the Loire Valley in the third quarter of the fifteenth century. If you compare the New Bedford Hours Annunciation miniature (below left) with the Annunciation in British Library Sloane 2732 B (below right, also attributed to the Masters), you can see the resemblance in the composition, the setting, and the treatment of hands and faces, even the structure of the Angel Gabriel’s wings and the gold cross-hatching that gives texture to the drapery.

New Bedford Hours, f. 29 v
British Library, Sloane 2732 B, f. 14 detail

Even if you’re not an art historian, you can at least get a sense of the date of the manuscript simply by looking at the border illumination. In the early fifteenth century, borders are comprised of delicate spindly vines (“rinceaux”) and small gold trefoil leaves. As the century progresses, colorful thick foliage begins to appear in the corners (“acanthus leaves”).

f. 13

By the third quarter of the century, the acanthus leaves have overtaken the rinceaux, as in this manuscript. By the end of the century, they’ve forced the rinceaux completely into the background and have come to dominate the border decoration.

Patients in the MHS with a new consultation to a primary care provider for standard diagnosis of LBP from January 1, 2007 to December 31, 2009 were identified. The date of new consultation was defined as the primary care index date. Patients had to be continuously eligible in the MHS database for 12months prior to and 24months following the index date to be included. A new consultation required that no care related to LBP was included in the MHS for 12months prior to the index date. LBP diagnoses were identified through standard ICD-9 codes (Additional file Breckelles Womens Almond Toe Slip On Slide Stiletto High Heel Pump Sandal Shoes Natural mZLDJkHYNI
). Only the first eligible index date for a patient was included, ensuring a patient was included only once in the study sample. Primary care providers were defined as Family Practice, Internal Medicine, or Flight Medicine providers. Other eligibility criteria included age between 18–60 on the index date, no co-morbid diagnosis of possible non-musculoskeletal sources of LBP (e.g., kidney stones, urinary tract infection, etc.) within 4weeks of the index date (Additional file Cattior Womens Comfy Indoor Outdoor Leather Slippers Ladies Slipper Rose Red da1uBz
), no prior history of spine surgery or spine trauma based on related current procedural terminology (CPT)-4 codes at any time prior to the index date.

We recorded age, gender, marital status, race, rank, and geographic region across 12 different geographic regions around the world. Visits at a military treatment facility (MTF) versus “purchased” care that occurred outside of a MTF but reimbursed by the MHS via TRICARE®, military service (Army, Navy, etc.), beneficiary status (active duty, retired, etc.), and use of opioid medication were recorded. We also recorded co-morbid conditions that might influence LBP prognosis, including mental health (depression, anxiety disorder, bipolar, schizophrenia, or other psychotic disorders), neck/thoracic pain, or fibromyalgia diagnoses by identifying the relevant ICD-9 codes over 12-months prior to the index date (Additional file NIKE Womens Flex Experience RN 6 Prem Running Shoe Cool/Grey/Mtlc/Cool/Grey/Black 1Hgp4lVY3
). The data set did not contain clinical data on symptom duration/location/severity, physical examination findings, potential psychosocial variables, or patient-centered clinical outcomes (ie. pain, function, disability, patient satisfaction, etc.).

We considered the 90-day period following the primary care index date to determine details about physical therapy utilization. If a physical therapy visit occurred with a LBP-related ICD-9 code during this period, the patient was defined as utilizing physical therapy. Within that time-frame, patients who were received physical therapy within 14days of the index date were defined as having received early physical therapy. The cut point of 14days was based on the threshold used in previous studies to classify early physical therapy [ AmoonyFashion Womens Buckle Open Toe Low heels PU Assorted Color Sandals Pink HcTUHtFddd
]. Those patients receiving physical therapy between 14 and 90days from the index date were defined as receiving delayed physical therapy.

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